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Sunday, August 09, 2009

'Mentally ill offenders strain juvenile system'

The title of this post is the headline of an informative New York Times article published today by Solomon Moore on the impact of mentally ill offenders in the juvenile system, including quotes from a Texas Youth Commission psychiatrist. Here's an excerpt:

As cash-starved states slash mental health programs in communities and schools, they are increasingly relying on the juvenile corrections system to handle a generation of young offenders with psychiatric disorders. About two-thirds of the nation’s juvenile inmates — who numbered 92,854 in 2006, down from 107,000 in 1999 — have at least one mental illness, according to surveys of youth prisons, and are more in need of therapy than punishment.

“We’re seeing more and more mentally ill kids who couldn’t find community programs that were intensive enough to treat them,” said Joseph Penn, a child psychiatrist at the Texas Youth Commission. “Jails and juvenile justice facilities are the new asylums.”

At least 32 states cut their community mental health programs by an average of 5 percent this year and plan to double those budget reductions by 2010, according to a recent survey of state mental health offices.

Juvenile prisons have been the caretaker of last resort for troubled children since the 1980s, but mental health experts say the system is in crisis, facing a soaring number of inmates reliant on multiple — and powerful — psychotropic drugs and a shortage of therapists.

In California’s state system, one of the most violent and poorly managed juvenile systems in the country, according to federal investigators, three dozen youth offenders seriously injured themselves or attempted suicide in the last year — a sign, state juvenile justice experts say, of neglect and poor safety protocols.

In Ohio, where Gov. Ted Strickland, a former prison psychologist, approved a 34 percent reduction in community-based mental health services to reduce a budget deficit, Thomas J. Stickrath, the director of the Department of Youth Services, said continuing cuts would swell his youth offender population.

“I’m hearing from a lot of judges saying, ‘I’m sorry I’m sending so-and-so to you, but at least I know that he’ll get the treatment he can’t get in his community,’ ” Mr. Stickrath said.

But youths are often subjected to neglect and violence in juvenile prisons, and studies show that mental illnesses can become worse there.

RELATED: A reader reminds me of this 10-minute video published on the Houston Chronicle's site in April describing TYC's mental health services and barriers to successful reentry for mentally ill youth after their incarceration is finished.

I am always skeptical when I read statistics like what is reported in this article. Too often, the statistics are taken at face value without any real analysis behind the numbers. I operate juvenile facilities in the state of Florida. We are a BHOS (Behavioral Health Overlay Services paid with Medicaid dollars) provider. BHOS services are above and beyond your normal daily rate. In Florida, where daily per diem rates are among the lowest in the country, you need BHOS services in order to keep your doors open.

So here is how the system works: upon admission a youth is given a comprehensive behavioral health assessment. The youth is then given a MH diagnosis that qualifies him/her for BHOS services. The diagnosis runs the gamut from benign to severe. In other states, the per diem rates are high enough whereby this exercise in survival is not necessary. This is a shell game that providers are forced to play. The state can keep their costs low and simply shift responsibility to the feds.

AS a Director of Security of a TYC facilty it is very hard to make sure youth who are admitted to Sec who have a mentally ill issue remain safe while they are in your unit. Shortages hurt us on a daily basis. If we have one that needs one on one sometimes it is hard to cover. You have copy cats who will do it just for attention. When you have 12-14 youth at once in your unit that are on suicide alert, you have one staff per wing, its a risk. As far as community support, alot of these youth have been admitted on simple charges due to hoping to get them help. However we are just as limited in TYC. We give a GAF, we give meds if they will take them, however the program is not designed for mentally ill youth. We look good on paper giving all kinds of prevention but the shortages hurt us when we have to take caseworkers and make them do JCO duties. We have so many level II hearings caseworkers are tied up doing paperwork instead of working with their caseloads. When you place general population youth with mentally ill youth, you are going to have more problems with perts and victims and unfortually it is the mentally ill youth who pays the price.

Looks like Florida is looking for mentally ill youth in order to increase their funds from Federal sources. Just being incarcerated is enough to make a youth crazy.

Texas TYC and MHMR (That's Texas Youth Commission and Mentah Health, Mental Retardation for the home gamers) are so bogged down in paperwork it is a wonder they ever actually get anything else done.

I always read that a mental health assessment is done upon entry to juvinile detention. Is this information ever updated as time goes by and the individual has a chance to improve or get worse? Does anyone ever improve? If not, what's the point of all that paperwork?

Grits,In regards to the problems addressed in the video, I believe legislation was passed this last session to bridge that gap. About the statistics claiming that Texas is losing no funding, I might agree if we had zero population growth. Also, we hear that Texas is so much better off than other states economically in mh spending, but, this is without considering the original per capita spending on mh issues to begin with. Texas is low whether we are in lean or fat times. Thus, when you are near rock bottom to begin with, you ain't going much lower!-stir crazy

This is a sad situation, and watching the video reminded me of so many kids I remember being at tyc back in my time. I’m glad to see that there are those who recognize the problem and I pray that something gets done. I did notice something hauntingly familiar with the boys in the video that were referred to as “youth ombudsmen”. These kids spoke like what we use to call “office boys”, tdc uses the term “row tender”. I know the prison culture at gatesville was transferred to the boys home at giddings so I’m curious if the “office boys” are now called “youth ombudsmen”?

So if a kid gets a mental illness discharge from tyc that kid is not eligible for mental health care?

So you'd prefer to wait until someone is hurt or victimized to address mental illness, 1:12?

That is exactly how I feel Grits. I'd prefer to see our state fight crime by focusing on criminals rather than engaging in social engineering. And aparently, state policy makers are moving in this direction. (At least on this issue.)

Texas has been ahead of the National curve when it comes to dumping mentally ill kids into the juvenile justice system. We have been doing it for 10 years. The person who posted as a Director of Security at a TYC facility cites just a few of the problems.

imprisonment of the mentally ill is social engineering. Treating youth with mental health problems in the community is not social engineering it is uh, whats the word, uh, health care? oh yeah. we don't need to reform that either.

In TYC the hard core criminal types take great pleasure in making life hell for their fellow students who are suffering from mental health problems. With so many bad actors, keeping an eye on and protecting those with severe emotional problems is very difficult. For those who like to put down hard working staff, I would like to see you try to run a dorm for a day.

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